Analysis of Maternal Near-Miss Events and Lessons for Quality Improvement in Tertiary Hospitals in Cross River State

Maternal near-miss review is a validated quality improvement methodology that identifies women who survived life-threatening obstetric complications, providing evidence for system improvements that prevent future maternal deaths. This study analyses maternal near-miss events and extracts lessons for quality improvement at tertiary hospitals in Cross River State. A retrospective record review and prospective case series design is applied, combining 24 months of retrospective near-miss record extraction from admission and theatre registers at two tertiary hospitals in Calabar, with prospective case documentation of newly occurring near-miss events over a six-month period. The WHO Near-Miss Assessment Tool criteria are applied to identify cases of severe maternal outcomes from haemorrhage, hypertensive disorders, sepsis, and obstructed labour. Structured mortality and near-miss audit meetings involving obstetricians, midwives, and anaesthetists are convened to identify avoidable factors. Both institutional and community-level delays are classified using the Three Delays Model. Descriptive analysis is conducted in SPSS, and fishbone diagrams are used to map root causes. Evidence from Cross River State's 2022 Maternal Death Surveillance and Response annual report indicates that preventable haemorrhage accounts for 38 percent of near-miss events, with blood transfusion delays and operating theatre unavailability as recurring avoidable factors. Findings will support Cross River State's maternal quality improvement taskforce in implementing targeted obstetric emergency protocols. Keywords: maternal near-miss, obstetric complications, quality improvement, tertiary hospitals, Cross River State.